EJACULATORY PRESERVING MIDDLE LOBE ONLY - TRANSURETHRAL RESECTION AND VAPORIZATION OF THE PROSTATE: 12 YEAR EXPERIENCE

After transurethral resection of the prostate (TURP), sexual adverse events, including erectile dysfunction (ED) and ejaculatory dysfunction (EjD), are significant concerns for patients. Using an intravesical prostatic protrusion (IPP) of ≥ 10 mm as the definition of a significant middle lobe, we report long-term safety and efficacy data on middle lobe only TURP (MLO-TURP).

METHODS

The study population consisted of 312 men (mean age 61.3 +/- 8.6) who presented with either significant LUTS (n = 147) or urinary retention (n = 175), had a minimum IPP of ≥ 10 mm, and were treated with either monopolar (n = 90) or bipolar (n = 222) MLO-TURP from 2005 to 2017. We evaluated: 1) efficacy: International Prostate Symptom Score (IPSS), Quality of Life (QoL), peak flow rate (Qmax), post-void residual urine (PVR), International Index of Erectile Function (IIEF) and ejaculatory function, which was assessed by the Male Sexual Health Questionnaire (MSHQ) and 2) Adverse events: catheterization time, blood transfusions, post-operative incontinence, and the need for subsequent therapy. Men were evaluated at 1 month, 6 months, and yearly thereafter.

RESULTS

Mean baseline prostate volume was 79.8 grams (30-178 grams); mean baseline IPP was 13.6. Improvements in IPSS, QoL, Qmax and PVR were durable throughout the study period (Table 1). There was no difference in outcomes between monopolar and bipolar MLO-TURPs. Postoperatively, the incidence of EjD was 2.6% (N = 8) and there was 1 case of new onset ED (0.3%). There was no significant deterioration of MSHQ-EjD at 5 years (baseline: 8.8 and at 5 years: 10.4) and there was modest improvement in bother due to ejaculatory function (baseline: 2.4 and at 5 years: 1.27). Seven (2.2%) patients required a second TURP and 1 patient required a blood transfusion. At 5 years, 14 (5.5%) men were on an alpha blocker and 6 (2.3%) were on an antimuscarinic medication.

CONCLUSION

MLO-TURP is a safe and effective treatment for men with LUTS. Patients experience long-term improvement of symptoms and preserve antegrade ejaculation. In select men with prominent middle lobes, MLO-TURP should be considered a therapeutic, ejaculation-sparing option.